Breast cancer is the most common malignancy in women accounting for about 30% of all tumors and is the second most lethal tumor in women, representing 16% of all deaths. This malignancy can occur at any age, but is unusual under 25 years. The peak incidence is between 45-60 years, with an occurrence rate of 1 in 232 in the fourth decade to 1 in 29 in the seventh decade. The frequency is increasing, particularly in younger age groups. In the Western Hemisphere, the lifetime risk for women is 1:12. It is 200 times more common in women than in men.
During the past three decades the introduction of screening mammography and other imaging modalities have brought about a greater knowledge and awareness of the characteristics of early breast cancer. Studies have shown that core needle biopsy (CNB) procedure is at least as accurate as open surgical biopsy in establishing definite diagnosis in mammographically suspicious lesions. The technique has gained popularity due to its accuracy, expedience, and practicality and is relatively inexpensive. CNBs of the breast are now considered to be the method of choice for the initial workup of mammographically suspicious breast lesions in many institutions. They have been shown to be highly sensitive and specific techniques for the management of patients with mammographically palpable and non-palpable abnormalities. Patients undergo stereotactic needle biopsy with commercially available vacuum-assisted percutaneous biopsy equipment using 8- or 11-gauge probe size (Mammotome, Biopsy Medical/Ethicon Endo-Surgery, Cincinnati, Ohio) or 9-gauge probe size (ATEC Breast Biopsy System, Suros Surgical Systems, Indianapolis, Ind.). Usually 3 to 18 core biopsy samples are obtained by the radiologist at any given time from each patient. These samples are sent to the pathologist for careful histologic evaluation where standard histologic protocols are followed. Multiple sections from each tissue block containing the core biopsies are routinely performed on all samples.
Radiologists and pathologists play a pivotal role in the diagnostic process by interpreting the results of numerous diagnostic tests. Both imaging and pathology tools are required to properly diagnose, stage or confirm accurate treatment of breast cancer. However, they generally make these interpretations independently and communicate them generally through written reports. This approach can lead to differences in treatment recommendations, creating uncertainty as to the best way to proceed with care and potentially having a negative effect on patient outcomes. Ideally, the pathologist should review the pertinent prebiopsy imaging and specimen radiographs to correlate the morphology of the radiographic target with the histology. Unfortunately, it is common practice to rely on a written description of the targeted lesion provided by the radiologist. Similarly, ideally the radiologist should personally review the tissue slides to assure that the targeted lesion has been properly recognized and diagnosed, and he or she should establish concordance between the histology and imaging and then propose appropriate follow-up care. Regrettably, this is not a common practice and radiologists most often rely on the pathologist's written report.
Radiologists, pathologists, surgeons, and oncologists must interact closely to achieve these common goals. Failure to follow this integrated multidisciplinary approach to breast biopsy specimen review may lead to a misdiagnosis. Ideally, the pathologist should review the pertinent prebiopsy imaging and specimen radiographs to correlate the morphology of the radiographic target with the histology.
Failure to perform proper correlation may result in:                Failure to recognize that the lesion was inadequately sampled        False negative delayed diagnosis of malignancy        Failure to recognize nonmalignant high risk lesions which should prompt additional testing or more aggressive clinical surveillance        